The CLRC has been very active lately, but little has been posted on our main website at www.RalstonCommunity.org , and it has been over a year since we’ve done a Neighborhood Update article. The reason for that is that much of what we have been putting out is now in the form of Facebook postings on our “CLRC Arvada” page.

Facebook is awkward to work with and to post photos on, nor do its articles archive well. But it is faster for shorter community announcements and articles there tend to get more interactive feedback from our members. Facebook articles only take minutes to post whereas a RalstonCommunity posting can take an hour or more to format and distribute via email depending upon the number of photos included. And article updates are difficult to distribute to our readers.

Copied below is a CLRC Arvada Facebook discussion that has been going on since January. It’s about the likelihood of the new stand-alone emergency room that has been open since November in the Arvada Triangle having to close down.

Brace yourself. It’s long Facebook series – about a dozen pages – and it’s mostly member commentary done by people who are often typing with their thumbs on their smart phones – and with all the small mistakes those devices tend to generate. It’s in chronological order, so the newest material is at the bottom of the page.

This is an experiment and suggestions are welcome. If the feedback for this kind of reporting is positive, I may do other “Facebook dumps” on other subjects.

–John

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John Kiljan via CLRC Arvada: New First Choice Emergency Room to Close?

First Choice Ads

We’ve all seen the ads for the new Emergency Room that moved into the old Blockbuster building next to the now-closed Safeway in the Arvada Triangle. It’s one in a series of for-profit ER’s now showing up across the country that want to take up some of the increasing demand for ER visits in major hospitals. It’s also the first in the Denver metro area. And it may be the first to have [to] close if a bill before the State Legislature [is] passed into law.

If it passes, SB 14-016, introduced by the Senator Irene Aguilar, who is the Chair of the Senate’s Health and Human Services Committee, would require the facility to close in two years if it is not taken over by a full-sized hospital — something that doesn’t seem very likely.

AURA regards the facility as a welcome addition to the redevelopment of the Triangle and as an attractant for new businesses to move into the area. But the for-profit ER’s are not without controversy. Below is a link to an article written last summer by Denver Post reporter, Michael Booth. It has a good summary of both the good and bad that goes with these new kinds of healthcare facilities.

This is an issue the CLRC intends to follow through this legislative session and hopefully we can report more on it later on.

Janet Ochsner Hi John – yes I’ve been to the Urgent care facility down by Sports Authority when I sliced open my hand a while back. They did an excellent job and were very reasonably priced. I’d definitely opt for them over this new facility.

John Kiljan Senate Bill 16 to ban independent ER’s in urban areas is scheduled to be heard by the SENATE HEALTH & HUMAN SERVICES COMMITTEE on the morning of February 12th. You may be able to listen in on the session by going to the Legislature’s online audio/video page during the meeting at this link

Ed C. Tomlinson When I was on the Arvada Fire Board there was a very serious problem with diverts in Metro Denver. Ambulances were trying to drop off patients to Lutheran hospital and were constantly being turned away. Ambulances while in route were forced to back track and go from hospital to hospital even though time was of the essence.

On request, Lutheran hospital leaders came to a board meeting to say that they turned them down because they might end up in intensive care. They also said they did not have the nurses. It was a chronic problem with all hospitals. When I asked what happens when a school bus gets T Boned they said they had procedures. I asked what the difference is. Silence. I gave them 30 days to figure it out or I would demand that of our contracted Arvada ambulances deliver the patient. They answered by putting all metro Denver ER availability on computers so the drivers knew where to go.

I also said to budget for more nurses and build a bigger intensive care unit. They did.

John Kiljan — Hello Ed, Whether you are for or against this bill the best thing to do now is to contact the Senate Health and Human Services Committee members. I suggest contacting the Democratic members first since they are in the majority — Aguilar, Newell, Kefalas and Nicholson. The bill could be killed in committee outright, but a better guess is that it will probably get a slug of amendments and move on.

Both Senators and Zenzinger and Jahn are reported as being against this bill but that could change depending upon what amendments come up. The Arvada City Council members are also very aware of it because of the impact on the Triangle’s development. But remember, there was a reason the bill was introduced in the first place.

Here is a click-on link that tells you how to contact the committee and its individual members. –John

The Senate Health and Human Services Committee considers matters concerning state health and welfare programs, health insurance, social services, and environmental health. The committee also has legislative oversight responsibility for the Department of Health Care Policy and Financing, the Departm…

John Kiljan As a side note, Michael Booth, the Denver Post reporter who wrote the “good and bad” article for the Denver Post referenced above has left the paper to take up an healthcare advocacy position. Here’s a quote from an Colorado Pols article:

“Q: Why are you leaving journalism? A: I’m shifting from one form of journalism to a form of advocacy journalism. I’ll be writing, editing and consulting for The Colorado Health Foundation, as we develop better methods to provide interesting and useful information to policymakers and decision-makers on some of the most important issues of the era. Health care, health coverage and healthier living are enormous fields, but also based on some fundamental needs and principles that all of us could do a better job explaining and reducing to a level we can grasp.”

First Choice Update: For those who are interested, Senate Bill 16 goes before the Senate Health and Human Services Committee sometime late Wednesday morning. The bill, unless amended, will probably close the new First Choice facility that just opened in the Triangle shopping center. The committee should meet upon adjournment of the full Senate sometime between 9:15 am and noon in room SCR 352.

You don’t have to travel down to the Capitol to listen in. These hearings are often available by a live audio feed from the meeting rooms. Go to Audio By Room and then click on SCR 352 at the link below. SB-016 is being heard after SB-018 and SB-101.

John Kiljan — Hi Jenny. There are four First Choice ER’s in Colorado. Two are in ski resort towns without full hospitals. It’s hard to argue that independent ER’s are not needed in locations like that, and the bill, as first drafted, specifically exempts them. The other two are in Arvada and in Colorado Springs. They compete with high-cost hospital ER’s like Lutheran in Wheat Ridge. –John

John Kiljan — I tuned in to the legislative feed about 11:30 am while SB-101 (regulating veterinary technicians) was heard. SB-016 was to be heard next, but the committee was abruptly adjourned after approving SB-101 on a mixed vote. –JK

John Kiljan — At the opening of the Senate Committee meeting today (Wednesday). Senator Aguilar, the sponsor of the bill and the chair of the HHS committee, announced that SB-016 would not be heard today because she wasn’t able to make it to a stakeholders’ meeting on the bill on Monday. The bill is no longer on the Senate calendar. –JK

First Choice Emergency Room Update: On a straight 4-3 party-line vote, an amended version of Senate Bill 16 passed out of committee late Thursday, February 27th. The bill is intended to close the newly built emergency room that has taken up the space that once housed the Blockbuster video rental store in the Arvada Triangle shopping center.

It will also close a similar one in Colorado Springs and prevent non-rural independent ER’s from opening elsewhere in Colorado.

The bill now goes to the whole Senate for a second reading on Tuesday morning, March 4th. This should be the last time Senators can make amendments to the bill before final Senate passage. The bill may pass on this second reading with only a voice vote.

The amendments already added to the bill are lengthy and sometimes involve technical requirements that I do not understand. There is also a provision that says that Exempla Lutheran can shut down the new Triangle ER by simply refusing to enter into a transfer agreement with First Choice.

But the bottom line is that First Choice is saying that the bill in its current form would require them to leave Arvada and Colorado Springs. That affects the redevelopment of the Triangle. And that affects the neighborhoods adjacent to it.

If you have thoughts about this – either for or against the legislation – now would be an excellent time to call your State Senator and share those thoughts.

–John Kiljan
jpkiljan@yahoo.com
303-423-9875

March 1

Jenny Riley Thanks for the update John. I used the First Choice ER this past week and hope it gets to stay.

T.O. Owens via Clrc Arvada: We should all call our state Senator. She has held herself to be an advocate for kids and the elderly. Those are the exact groups that would be most hurt by the ER closing. We will quickly see if her loyalties are to those she serves or her party. T.O.

John Kiljan — Both Senators Zenzinger (Arvada) and Jahn (Wheat Ridge) have said that they are opposed to this bill and voters should probably take them at their word. Both are Democrats, and Democrats are the majority party in both houses of the General Assembly. Final votes in both the Senate and the House are always recorded and you’ll hear about it here if they should later change their positions.

What’s probably more important are the positions taken when each party caucuses and decides what bills they are going to support. And that’s where things get a little less democratic and a lot more secretive.

Those are closed meetings. No member of the House or Senate has to follow the recommendations of their party caucus. But if they don’t, they risk not getting party support when they run for reelection and they may find that their party will not support their own introduced bills. It’s a little ugly, but it’s politics, and that’s the way things have been for a long time.

So for those who are opposed to closing this ER facility, the question should not be whether our two Colorado State Senators vote aye or nay, but what will they do to sway other members of their party to support their positions.

BTW, Senator Rachel Zenzinger’s contact information is

SenatorRachelZ@gmail.com or rachelforcolorado@gmail.com or r.zenzinger@comcast.net 303-866-4840

Unless it gets laid over yet again, Senate Bill 16, which will close the new ER room in the Arvada Square part of the Triangle, will reach the floor of the Senate for a vote tomorrow morning, Friday, March 14th.
I called and talked with a First Choice representative for the first time today. She said that there is another amendment pending that is worse than the preceding one and the way it is written it will definitely put them out of business in Colorado the day the Governor signs it.

She also said that she thought the reason the bill kept getting held over is that there are not currently enough votes to pass it in the Senate. Local Democratic Senators Zenzinger and Jahn are still in opposition and that is because of contacts from their constituents. They have also been getting lobbying for the bill.

When I had got back in town earlier this month, I took the time to download and listen to the two hours of Senate committee testimony on the bill.

First Choice’s representative at the committee hearing seemed a little unprepared since she had not been given an advance copy of the substantial amendments being made to the bill. But there was still a lot of information available.

First Choice neighborhood mailing

The two urban emergency rooms First Choice operates in Colorado Springs and in Arvada have 90 employees working for them and the average employee makes $65,000 a year in salaries. Presumably half of that work is going on in Arvada. With 24-hour coverage, there are typically at least four people on staff at any given time. There is a police panic button for patients who are having psychotic problems, and they can do all the lab tests a regular ER can do.

These private ER’s are doing very well in Texas which has a lower overall ranking in emergency care than Colorado (D for Texas vs C+ for Colo according to ACEP). Those Texas rankings do not include private stand-alone ER’s run by First Choice in Texas which provide higher-quality care.

The proposed bill coming out of the committee would prohibit non-rural private ER’s to charge for things like building overhead, medical supplies, nursing and other staff support. These are called “facility fees” and make up a large part of the charges patients typically receive after an emergency-room visit at a hospital.

First Choice says 25% of their patients are treated for free. No questions are asked about insurance before they are seen by a doctor. Apparently, for about 40% of the patients who visit any ER, it is not a real emergency, but a perceived one. A typical ER visit costs about $1200, but it can run much higher for some patients.

Anthem testified against the [free-standing ER’s] saying that they didn’t want to have to pay higher insurance reimbursement costs for their patients. Anthem currently negotiates lower rates with hospitals for their portion of emergency care payments, but they have not yet started to do that with private ER providers. Oddly, the Catholic Sisters of Charity Leavenworth who runs Exempla Lutheran Hospital in Wheat Ridge did not take a stand on the bill.

Highly experienced ER physicians from several hospitals testified [for] the bill saying they did not want the competition for their own personnel. Apparently, there is a high burn-out rate in hospital ER’s because of stress. They also questioned the quality of care.

Exempla Lutheran ER (aka Emergency Department)

Two ER doctors from First Choice (also highly experienced) testified for the private ER’s saying that the low-stress environment and the fact that they were not rushed in dealing with so many patients at one time is what makes the job attractive. They strongly contested the quality-of-care assertion saying that they were providing better care than they could when they used to work in public hospital emergency rooms. They said they were able to attract the best ER talent because of the better working environment. And the salaries paid were indeed better.

They also talked about their ability to take some of the load off of public hospitals when there are civil emergencies or simply high case loads.

The bill’s sponsor said that market forces could not be allowed to work in ER treatment since it would drive up costs for regular hospitals. This idea was strongly rebuffed by the members of the committee in opposition.

Michele Hoffmann Thanks for detailing this for us. What a step back this will be if Senate Bill 16 is passed. I don’t understand how the goal of eliminating competition is a valid argument to shut the ER’s down.

John Kiljan — Hello John [Marriott], the 4-3 committee vote was along party lines. The full Senate vote may not be. We’ll see.

— Hello Michelle, yes, you are right. Eliminating competition is not a valid legislative goal. But eliminating unfair competition is. This bill looks like it is only going for the kill.

I don’t like that. Nobody should.

What I’d like to see instead is something that both public quasi-subsidized ER’s and the private ER’s can agree to for the public benefit. The General Assembly can do that if they try. Right now they are not trying.

If you have a moment, do try to read former Denver Post reporter Michael Booth’s article on this subject at

Ed C. Tomlinson It’s all about money, not heath care. The big guys don’t want competition and they are abusing the system just like they do in D.C. Check their political donations. This didn’t happen for the public good.

John Kiljan Update: My computer decided it needed to reboot about one minute before the bill was heard on the Senate floor so I missed the discussion, but the bill status sheet now says “Laid Over Daily” which I assume means that it will go on the calendar for Monday morning, March 17th. –JK

John Kiljan — If you are looking for something to do this weekend other that enjoying the St Patrick’s Day celebrations in Olde Town or the fine weather predicted for Sunday, you can listen to the audio of the February 27th Senate Health and Human Services committee hearings on the bill at this link. The hearing starts at the 1:29 mark on the tape. — JK

Lorraine M. Anderson Thanks, John. I think that the legislature just has to meddle. Hope Zenzinger and Jahn hang in there on this. It is unnecessary legislation. Another way to make health care cost more.

“The competition for emergency-care dollars is intensifying on two fronts — in the state legislature and in the suburbs, where hospitals and entrepreneurs are busy building free-standing emergency rooms. . . “

John Kiljan — An informative article, Tracy. Thanks for taking an interest. With two senior housing facilities already located in the Triangle and at least one more planned, the real benefit to having this facility in Arvada may come when the federal government starts allowing them to take Medicare/Medicaid patients. Right now they don’t.

I’ve spent more hours than I can remember with my elderly parents waiting to see a doctor for 15 minutes at Lutheran’s ER as more urgent patients were tended to first. I don’t blame Lutheran’s doctors. They are doing the best they can with the caseload they have. But it would be nice to have a choice even if I have to pay more out of pocket.

I’m over 65 so there’s nothing in this for me right now except a better neighborhood to live in.

Timothy D. Allport It is not that simply. The sponsors intent is not to close the Facility, but if they are getting and taking advantage of facility fees available to the ER’s they should have to operate under the same standards and rules as hospitals like Lutheran medical center. That is my understanding, The fees, standard of care and financial health of the hospitals is what the bill is about.

Brian Vande Krol Representative Zenzinger, thank your opposition to a bill that would eliminate choice for consumers. Representative Kraft-Tharp, the majority party ran on a jobs platform. Closing businesses does not square up with that objective. Please oppose the bill, should it come your way.

Cheryl Cheney Not sure I can agree with stand alone ERs operating in an unregulated market. There is too great of a potential for these groups to drive up the cost of health care without actually improving the standard of care. While I understand their ability to reduce the wait times for patients, the excessive cost of the facility is not justified.

“State Sen. Irene Aguilar, D-Denver, has taken a flawed bill targeting free-standing emergency rooms and amended it into a measure that lawmakers can embrace without fear that they might be stifling competition in medical services. . . .”

John Kiljan — The best quote from the article above is, “Our only complaint regarding Aguilar’s bill is that it fails to treat free-standing ERs built by hospitals in the same fashion. Ironically, most of the state’s stand-alone ERs, as Denver Post reporter Electa Draper noted in a recent article, are run by hospitals themselves.”

Please read the entire editorial. The bill would NOT close your ER and it would protect you from unfair billing practices that will make private insurance more costly. I am happy to discuss this with you.

T.O. Owens via Clrc Arvada: Senator Aguila, if you bill is it meant to protect us from higher fees why not ban stand alone ER’s run by hospitals from charging facility fees? Should we not treat all of the businesses fairly and evenly? I am sure you have a good reason for treating them differently and I think we would all like to hear it. T.O. Owens 303-927-8888

T.O. Owens via Clrc Arvada: I will contact out steering committee and see if there is interest in that. What is the best way to contact you. T.O.

March 21

John Marriott I would love to hear a discussion of this in a community forum. Kudos to Senator Aguilar for being willing to be available.

March 21

John Kiljan — T.O. Owens asked, “Do any of you have interest in this?”

My answer: Yes. The bill was laid over yet again until Monday. I expect it will continue to be laid over until the votes are there — and that could take weeks. Let’s see if we can have it at the Arvada ER waiting room. –JK

T.O. Owens via Clrc Arvada: Senator Aguilar, we are looking for a meeting room now. Could you please call me about setting up a day and time T.O. 303-927-8888

March 21

Irene Aguilar I can call in am as I have committee this afternoon. I will ask my aide Gaby to call this afternoon. Thank you! We can also arrange to meet at a library.

March 21

John Kiljan – Senator Aguilar wrote, “Please read the entire editorial. The bill would NOT close your ER and it would protect you from unfair billing practices . . . “ Dear Senator Aguilar, this is an astonishing statement. So please take a moment to read this editorial as well:

I have read the entire DP editorial and I’ve read it more than once. I’ve also read the original bill, its amendment (as pre-amended in the bill folder), and I have listened in on the entire two-hour Senate hearing held by the Health and Human Services Committee that you chair. I’m not trying to be impolite, but your statement makes me wonder if you are really aware of what is in your own bill. I’m also wondering who actually produced its first draft and who drafted the HHS committee amendment to it which squeaked by on a 4 to 3 committee vote.

If we are to have a neighborhood forum, it would be good to first think about the questions to be asked in that forum. Here are a few that come to my mind:

If the bill will not close First Choice in Arvada, why does First Choice say it will put them out of business the day the Governor signs it? Even the first version of the bill had a two-year transition period for implementation. The current version has none. Independent ER’s are already licensed by the State.

If this legislation was not intended to put First Choice out of business, why did the first version of this bill say that only hospitals can run ER’s? Would not shutting down a business that may have cost one or two million dollars to set up in Arvada and Colorado Springs amount to a “taking” by the State of Colorado?

Why does the pre-amended version of this bill say that First Choice cannot be allowed to operate if Exempla Lutheran in Wheat Ridge simply declines to enter into a transfer agreement with First Choice as its nearest hospital? Does that not give Exempla Lutheran absolute control on whether or not First Choice can continue to operate in Arvada?

Complementary electric vehicle charging station at the Arvada ER

Why does the bill say that it will be fraud for First Choice to include charges for its overhead water, sewer, lights, insurance, medical supplies, nursing assistance, administrative support and even its eco-friendly hybrid vehicle charging stations? Why does the bill allow competing hospital-sponsored ER’s to continue to bill for these facility-fee charges? Did YOU read the part of the Denver Post editorial where it said the editorial board viewed this uneven treatment of stand-alone ER’s as the bill’s primary flaw?

Can you imaging a business like Pizza Hut or King Soopers being able to operate without being able to pay for the cost of its electricity, parking lot maintenance or its food preparation staff?

Why does the bill eliminate the need for other hospital-affiliated ER’s to get a license from Colorado Department of Public Health and Environment (CDPHE) for their ER rooms as they are currently required to do now? Should not all ER’s have to be certified by the State in the same way?

And can you show us your next proposed amendment to this bill before it hits the Senate floor? Even a draft will be helpful. With the bill being laid over so many times for a lack of votes, you must have another draft amendment in the works. This CLRC Arvada Facebook page would be a great place to post it and we can distribute it more broadly on the neighborhood association’s website at www.RalstonCommunity.org .

And wouldn’t it be a good idea to lay over the bill until after we have a neighborhood forum discussion on the bill’s impact? That would seem to make sense if the purpose of the forum is to receive neighborhood feedback for what is being proposed.

If this bill does what it appears it will do, it will hurt our Arvada neighborhoods. This area needs business revitalization. It needs it badly. The new First Choice facility is the first in many, many years to provide some of that revitalization. Most of us hope it will encourage others to co-locate here with the business traffic it generates.

And why not instead wait for a couple of years to see how these new ER’s really do play out? To see how much traffic or patient overload they do take from hospital-based ER’s, to see if there really are billing abuses, to see if insurance companies like Anthem can negotiate lower preferred-provider rates with them like they do with regular hospitals, to see if the competition they offer really does raise our insurance rates, and most importantly so see if the quality that First Choice says is there is really there?

Let’s go a little further. No doubt you are aware that the implications of this bill go beyond the issue of closing down a local business that is important to the health of the community we live in. Considering the history of this Senate District, the coming election for SD 19 is likely to be hard fought and its outcome may well determine whether the State Senate remains in Democratic hands after the November elections.

And think for a moment what Republican and, especially, independent voters must be thinking about a bill that presents itself as being so anti-competitive, so anti-business and so anti-freedom-of-choice that it makes one wonder if the party supports a free market for services that do not naturally tend to form monopolies. Even hospitals themselves operate under a competitive free-market system.

And you are hearing all this from lifelong Democrat.

Sincerely,

– John Kiljan (speaking for himself and not as a member of Arvada’s Citizens for a Livable Ralston Community neighborhood association)
March 22, 2014

UPDATE ON MARCH 24, 2014:

Irene Aguilar: Thanks for your questions John. I look forward to answering them on Sunday! Sen A
March 24, 2014

Clrc Arvada We will be hosting a community forum with Senator Aguilar on Sunday March 30th at 1:30pm. We will be meeting in the Ann Campbell room at city hall. Grab your friends and neighbors and come meet Senator Irene Aguilar.
March 24, 2014

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WHERE TO FIND OUT MORE
This discussion is best followed on Facebook on our “CLRC Arvada” page. You have to register with Facebook to view the page, but there is no other obligation unless you want to post comments yourself. If you do want to leave comments, you must first “friend” CLRC Arvada and wait a day or two for approval. The page manager, T.O. Owens, does not allow anonymous posts, posts that appear to be libelous, or posts that are just plain insulting.

Also, you can look in on our www.RalstonCommunity.org website periodically to see if there are updates. If you are on our email distribution list, you may not get those updates emailed to you – only the new posts. We do that to cut down on email clutter.

Photo credits: The First Choice sunset photo is courtesy of First Choice. The Lutheran emergency room photo was taken from Exempla Lutheran Medical Center’s Facebook page. Click on any image to enlarge it.

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Why Are We Here?

There are no secrets here. The idea for a Citizens for a Livable Ralston Community
neighborhood association started with a suggestion by Arvada City Councilor Shelley
Cook to two local residents, T.O. Owens and John Kiljan. We were two of a number of
local residents who thought that the City was moving too fast on its redevelopment plans
for the North Jeffco Community Park. Ms Cook's suggestion was that local community
members would have more say in influencing public policy of we could organize, even if
it were just a loose organization.
Starting up any neighborhood association is a lot of work. If you don't believe that,
volunteer with us to distribute organizational fliers on a windy day, or write a few articles
or news reports on items of neighborhood community interest -- not to mention the effort
in setting up and maintaining a website.
We did not want to make that kind of effort if it were only to provide feedback on the
park. Other community issues are on the horizon including the reconstruction of Ralston
Road from Olde Town to Kipling and the integration of AURA's plans for the renewal of
the Triangle shopping district. After some discussion, we decided to make the attempt
only if the association were designed to cover broader community-development issues.
The suggestion for the name, Citizens for a Livable Ralston Community, came from RTD
board member, Lorraine Anderson.